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Fron:Harcus H. Bole & Associates 530+633+0119 05/18/2012 10:22 #239 P.001 <br /> DAT E AHD LOG NUMBER <br /> �} SAN JOAQUIN COUNTY <br /> 1�1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 952D2-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PJtvs© ��R�>c s� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT• U1 <br /> Lam- t� _BUSiNESSIAGENCY• �e* or,;, <br /> Lt <br /> .5 <br /> ADDRESS: l - y CitylStatelzip7 e <br /> PHONE(1): PHONE(2): �� � ! IS ` 61W r 4) FACSIMILE: .� e b� i7 <br /> TENTATIVE`APPOINTMENT DATE: r-Apm MAY a�- Time: <br /> (Please allow 10 business days from date of applicationsub�Tentafve only-must 6e confirmed] <br /> El CHECK BOX To EXPEDITE RE4 T-$105 FEEjCAS_jA OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT �� DATEEZW <br /> Electronic Information: [] List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# A Street Name City <br /> 14 , , - <br /> 1�1 S. fC t�j2�" + ` --- ❑''t7ni't`1 i W� <br /> r <br /> 2. r- S /1i-jIQ04X- <br /> 3. <br /> • # / Unit 3 <br /> 4. 1y� <br /> N 'Ilan <br /> -- � 1�o1 <br /> 7. CLI. 0 /V l © ❑ Units <br /> I <br /> 9. Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:Fromto � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HousING ABATEMENT ,a,(,SOLID WASTE FACILTYIVEHICLE 1 /� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY �KWASTE TIRE <br /> UNDERGRouND TANK(MONITORINGIREMOVAL) 4�_ ❑DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH In WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY d MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑TATTOOIBODY PIERCING ❑PODUSPA El I AND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY F OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONOAY•FRIDAY 8:00 Am-5'10P - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At feast one file type MUST be selected. Fax to(209)464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:D0 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD US ONLY 1 <br /> /11� q55` s rI <br /> Wt k21- <br /> b ' <br /> EHD 4 -06 8104108 . n P g <br /> For qCO� 6I 01) d O. aiY)PI�rli *(R)D03500' 1A 4W�r�lp' ;or ids I �p�.r com caznl <br /> 51 (.O17t7-�`'1 Z'i fa. r,��'I���sti� ..I. r,n,�Fl�enu fe �,.-,�• .. �. r_•I „ [., P. ��i�_-� �.,-.rr�'. <br />